ARKANSAS STATE HEALTH ASSESSMENT (SHA) 2023
ARKANSAS STATE HEALTH ASSESSMENT (SHA) 2023 SCORECARD
The Arkansas State Health Assessment (SHA) 2023 Scorecard is the electronic companion of the Arkansas State Health Assessment Report published in December 2020. Both Scorecard and the book are updated and upgraded editions of the 2013 publication “Arkansas’s Big Health Problems and How We Plan to Solve Them”.
The purpose of SHA is to provide comprehensive data on the health of Arkansans including risk factors contributing to their poor health outcomes. In addition to data, the book also identifies public health, health care, and other resources available in the community to help improve the health status of Arkansans. The SHA Scorecard is also the foundation for the State Health Improvement Plan (SHIP), which serves as a blueprint for actions to be taken to address the issues identified in the SHA.
The Scorecard primarily presents data in graphics and sometimes tabular formats, highlighting multiple year trends of behaviors, diseases, and deaths. Since the Scorecard does not provide narrative and the illustrations contain layers of information, two tools have been developed to enable users to navigate the Scorecard and gain most out of the information. A brief PowerPoint presentation provides basic guidance on how to navigate through any Scorecard, while a more detailed video provides more comprehensive guidance on how to navigate through the SHA Scorecard specifically.
The scorecard will be regularly updated to demonstrate changes that may occur in the health of Arkansans in future.
Health Disparities
An individual’s health is impacted by many factors, including their race, age, sex, income, or disability. Health disparities, when one group has a much higher rate of disease compared to another, is particularly pronounced for different racial and ethnic groups in Arkansas.
There are more than 2,054,900 non-Hispanic Whites in Arkansas, which makes non-Hispanic Whites the largest racial group at 67.5 percent in 2022. There are more than 435,600 non-Hispanic Blacks in Arkansas, which makes Blacks the second largest group with 14.3 percent of the population. Hispanics are classified as an ethnic group and they comprised 8.5 percent of the state’s population in 2022. While the percentage of non-Hispanic Blacks in Arkansas is higher than the average for the U.S. as a whole (12.3%), the percentage of Hispanics is considerably lower than the national average (17.1%).
Arkansas Percentage of Population by Race/Ethnicity, 2013-2022
|
RACE |
2013 |
2014 |
2015 |
2016 |
2017 |
2018 |
2019 |
2020 |
2021 |
2022 |
|
White (non-Hispanic) |
73.6 | 73.4 | 73 | 72.8 | 72.3 | 72.1 | 72 | 68.5 | 68.2 | 67.5 |
|
Black or African American (non-Hispanic) |
15.4 | 15.7 | 15.7 | 15.5 | 15.2 | 15.1 | 15.4 | 14.9 | 14.7 | 14.3 |
|
American Indian and Alaska Native |
0.6 | 0.6 | 0.7 | 0.6 | 0.6 | 0.7 | 0.6 | 0.5 | 0.6 | 0.7 |
|
Asian (non-Hispanic) |
1.3 | 1.2 | 1.4 | 1.4 | 1.6 | 1.5 | 1.5 | 1.5 | 1.4 | 1.6 |
|
Native Hawaiian and Other Pacific Islander (non-Hispanic) |
0.0 | 0.2 | 0.3 | 0.3 | 0.3 | 0.3 | 0.4 | 0.3 | 0.4 | 0.5 |
|
Two or More Races (non-Hispanic) |
2.0 | 1.9 | 1.9 | 2.2 | 2.4 | 2.5 | 2.4 | 3.1 | 6.5 | 7.0 |
|
ETHNICITY |
2013 |
2014 |
2015 |
2016 |
2017 |
2018 |
2019 |
2017 |
2018 |
2019 |
|
Hispanic (all races) |
7.4 |
7.6 |
7.7 |
7.9 |
8.1 |
8.3 |
8.5 |
8.1 |
8.3 |
8.5 |
|
Not-Hispanic (all races) |
93.1 | 93.0 | 93.0 | 92.8 | 92.6 | 92.4 | 92.3 | 91.5 | 91.8 | 91.6 |
Source: U.S. Census Bureau, Population Division
Why Is This Important?
To understand the health problems facing the state it is important to look at the people and how they live. There are close to three million people living in Arkansas. Children under the age of 18 make up just below 23 percent of the population while individuals over 65 make up just under 18 percent, with both rates closely resembling the rates for the U.S. There are 540,300 people in Arkansas who live with a disability, not including those who live in nursing homes. This is 18 percent of the total population, which is much higher than the U.S. rate of 13 percent.
The population in Arkansas is highly concentrated with nearly one-third of the state’s population residing in just three counties – Pulaski, Benton and Washington.
Population in Arkansas by county, 2022
Data Source: U.S. Census Bureau 2018-2022 American Community Survey Population Estimates
Health Disparities
|
Many health disparities are linked to an individual’s socioeconomic status which can be determined by a family's income level, education level, and occupational status. Research has clearly identified a significant relationship between poverty, socioeconomic status, and health outcomes—including increased risk for disease and premature death. With a poverty rate of 17 percent, Arkansas has the fifth highest rate in the U.S. A variety of factors can contribute to inequitable access to resources and opportunities, which may result in poverty. Marital status, education, social class, social status, income level, and geographic location (e.g., urban vs. rural) can influence a household's risk of living in poverty. Racial and ethnic minorities are more likely than non-minority groups to experience poverty at some point in their lives. In addition, children from families that receive welfare assistance are three times more likely to use welfare benefits when they become adults than children from families who do not receive welfare. Residents of impoverished neighborhoods or communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy. Some population groups living in poverty may have more adverse health outcomes than others. For example, the risk for chronic conditions such as heart disease, diabetes, and obesity is higher among those with the lowest income and education levels. In addition, older adults who are poor experience higher rates of disability and mortality. |
Why Is This Important?
In addition to an individual’s racial or ethnic group and where they live, many other factors have an impact upon their health, influencing not only their likelihood of suffering from a particular disease, but their opportunity to access health care and to practice healthy lifestyles.
Health Disparities
The rate of obesity varies across different demographic characteristics with higher rates in rural areas, in areas characterized by food deserts, and across different race and ethnic groups.
Why Is This Important?
Obesity is a health problem that can lead to several types of chronic diseases, especially diabetes. In Arkansas, more than 7 in 10 (almost 71 percent) of adults are either overweight or obese. People who live in the counties with the shortest life expectancies are even more likely to be overweight or obese.
A lack of physical activity can hinder a person’s ability to maintain a healthy weight and is a top cause of chronic diseases.
Health Disparities
Life expectancy is impacted by many factors, including an individual’s race or ethnicity, and where they live in the state. All but one of the 75 counties in Arkansas had life expectancies lower than the national average. Benton County in northwest Arkansas had the longest life expectancy, which was 78.2 years. Phillips County had the shortest life expectancy of 67.2 years. This is a 11-year difference in life expectancy compared to Benton County. Most of the counties with the lowest life expectancies are in eastern and southwest areas of the state.
Life expectancy in Arkansas by county in 2021
Data Source: Arkansas Department of Health, Health Statistics Branch
Why Is This Important?
Life expectancy is a general way of measuring the overall health of a population. It is defined as the average number of years a person is predicted to live, based on the death rates for the year being studied. In 2021 the average life expectancy in Arkansas was 73.6 years. This was about two and a half years shorter than the U.S. life expectancy, which was 76.1 years.
Another important mortality indicator measures premature mortality which focuses attention on deaths that could have been prevented. This measure - Years of Potential Life Lost (YPLL) - is used to measure the rate and distribution of premature Mortality and to, thereby, address issues of the impact of disease and death and their costs to society.
Health Disparities
A lack of sufficient dental providers is one barrier to accessing oral health care and this is prevalent in a number of rural areas in Arkansas. Sixty percent of the state’s dentists practice in just eight of the state’s 75 counties, although these eight counties have only 40 percent of the state’s population. Sixty-five Arkansas counties are designated whole or in part Dental Health Professions Shortage Areas (HPSA) and these are mostly in rural areas.
Dental Health Professional Shortage Areas, Arkansas 2023
Why Is This Important?
Poor oral health, which pertains not only to teeth but to the health of the whole mouth and related structures, is another factor that contributes to poor health. Tooth decay in young children can begin shortly after the eruption of their first tooth. When a child starts life with tooth decay, they are much more likely to have severe dental problems as an adult. Untreated dental disease can lead to serious health effects including pain, infection, and tooth loss. In worst cases, untreated tooth infections and abscesses can lead to death. Poor oral health can also cause cancers of the mouth or pharynx.
Health Disparities
The infant mortality rate varies considerably by race, with the rate for blacks (2021) being twice as high as that for whites or Latinos. The rates also vary by geographic area, with some counties in Arkansas having rates four times higher than the rates in other counties.
Infant mortality rates in Arkansas by county for 2017 to 2021
Data Source: Health Statistics Branch, Arkansas Department of Health
Note: Data are provisional and may change. Some counties experienced a small number of infant deaths (less than 10) during this five-year period; therefore, caution should be taken when interpreting the data.
Why Is This Important?
High infant mortality is an indication of serious public health problems. Arkansas has a higher infant mortality rate (death of the infant in the first year of life) than the average for the U.S., a higher neonatal mortality rate (death of the infant in the first 28 days of life), and a higher post-neonatal mortality rate (death of the infant between the ages of 28 days and one year).
Health Disparities
Higher rates of incarceration are often seen among racial/ethnic minorities and people with lower levels of education.
Why Is This Important?
The United States has the largest prison population in the world and the number of people in prison in Arkansas is growing faster than any other state. Incarceration can affect the health and well–being of those currently incarcerated, those with a history of incarceration, and their families and communities. The financial security of a family can be significant impacted by the incarceration of a parent and this, in turn, can make it less likely that children in these families will live in neighborhoods with good schools, have safe and affordable housing, or have good jobs.
Health Disparities
Research shows that children in low-income households or those belonging to racial and ethnic minority groups have disproportionally greater exposure to ACEs compared to white children, and that they experience significant disparities in both early brain development and healthcare access as a result of increased exposure.
Why Is This Important?
Many children in Arkansas suffer an intended or unintended adverse experience which may cause physical, emotional, or psychological harm that cause delays in the development of their social, emotional, or mental abilities. The effect of these experiences can have lifelong health consequences.
Adverse Childhood Experiences (ACEs) Rates in Arkansas, 2018
Data Source: Child Trends, Research Brief, Updated February 20, 2018
In Arkansas, almost 6 in 10 (56%) children have experienced at least one ACE and over 29% have experienced two or more. Both rates are higher than in the United States as a whole, where less than 5 out of 10 children have experienced at least one ACE and 21% have experienced two or more.
Percentage of Children (Birth – 17) and Number of ACEs, AR and U.S.
|
|
0 ACEs |
1 ACE |
2 ACEs |
3 to 8 ACEs |
|
United States |
55 |
24 |
11 |
10 |
|
Arkansas |
44 |
27 |
13 |
16 |
Data Source: Child Trends, Research Brief, Updated February 20, 2018
Health Disparities
Opioid prescribing varies among the regions in the state.
Opioid prescription rate per 100 people per county based on patient address, Arkansas, 2019
Data Source: Arkansas Prescription Drug Monitoring Program
Overdose death rates per 100,000 people per county based on individual address, Arkansas, 2019
Data Source: Arkansas Prescription Drug Monitoring Program
Why Is This Important?
Drug-related deaths are the second leading cause of unintentional injury-related death in Arkansas and in 2019, the prescribing rate for opioids in Arkansas was the second highest in the nation. High levels of availability of prescription opioids creates more opportunities for misuse and addiction among those at risk.
Health Disparities
People in rural Arkansas are impacted by a shortage of health care options and professionals in their communities. Many of the rural counties have been designed as Medically Underserved Areas (MUA) and have also been identified as suffering from shortages of Health Professionals in Primary Care, Mental Health Care, and Dental Care. For example, rural areas in Arkansas have 73 primary care doctors for every 100,000 residents, while cities have 133.
Arkansas medically underserved areas, 2023
Data Source: Health Resources & Services Administration, 2023
Arkansas Primary Care Health Professional Shortage Areas, 2023
Data Source: Health Resources & Services Administration, 2023
The ability of rural residents to cover the cost of healthcare also contributes to poor health outcomes in these communities.
Why Is This Important?
We know that people who live in rural counties tend to have shorter life expectancies. Babies in those counties tend to have higher infant death rates. And the people there are more likely to struggle with low health literacy.
In many ways people who live in Arkansas’s rural areas have the same barriers to good health as people who live in Arkansas’s cities. However, they may also experience barriers that people who live in cities may not. For example, people who live in rural counties have higher rates of chronic diseases and are more likely to be involved in serious accidents. Yet people who live in rural areas must travel greater distances to see a doctor or go to the hospital. In some rural counties, there are no hospitals. People who live in rural communities may not have grocery stores where they can buy food for a healthy diet, such as fresh fruits or vegetables. Barriers such as these must be removed if we want all Arkansans to have the same chance to enjoy good health.
Nearly half of Arkansans – 41% - live in rural areas, with 53 of the 75 counties in the state being classified as rural.
Rural counties in Arkansas, 2021
Data Source: University of Arkansas in Little Rock, Rural Profile 2021
Health Disparities
Food insecurity is particularly prominent in rural counties, with some having rates considerably higher than the State average of 16%. Rural Phillips County, for example, has a rate of 21% and 5 of the east Arkansas rural counties adjacent to the Mississippi River have rates of at least 18 percent.
Food Insecurity in Arkansas, 2021
Data Source: Feeding America
While food deserts can be found throughout the entire State, they are particularly prevalent in rural counties.
Food deserts in Arkansas, 2015
Data Source: U.S. Department of Agriculture Economic Research Service
Why Is This Important?
An estimated 16% of Arkansans suffer from food insecurity, although this rate varies considerably by different regions in the State. Food insecurity has a disproportionate impact upon children as it can permanently change a child’s brain development, resulting in learning difficulties and poor social skills.
Food deserts, places where convenience stores and fast food restaurants provide the main source of food for residents in these areas, are a main cause of hunger and increase the risk of obesity in children and adults.
Health Disparities
Data indicates that of the main racial/ethnic groups in Arkansas, Hispanics have the lowest level of smokers at 11.5% (2022), compared to 19.9% for Blacks and 18.6% for Whites.
Why Is This Important?
Tobacco use is the most preventable cause of death in Arkansas. It is a leading cause of short life expectancy in the state and is a major contributor to chronic diseases such as heart disease, cancer, chronic lung disease, and stroke. In addition to this human toll, smoking is estimated to result in $1.3 billion a year in medical treatment and $1.7 billion in lost productivity. While the percentage of adults who say they are smokers has gradually decreased in the last decade, the 2022 rate of 19.3% is considerably higher than the rate for the U.S. as a whole (14.0%).
Health Disparities
Although new treatments now mean that HIV is treated as a chronic disease rather than a fatal illness, the success of these treatments is impacted by an individual’s ability to begin treatment early in the disease. This access varies for different groups, particularly among low-income populations and those who are uninsured. The mortality rate for HIV also varies by race in Arkansas, with the death rate for blacks being almost 5 times higher than for whites.
Why Is This Important?
Human Immunodeficiency Virus (HIV) is an important marker for a range of risky health behaviors and it can put a significant burden on the population and the health care system, with estimates suggesting that HIV can cost nearly $40,000 a year to treat the infection for the rest of one’s life.
Health Disparities
From 1993 to 2010, the number of TB cases reported in the United States decreased from 25,103 to 11,182. Despite the decrease, TB continues to affect many communities in the United States disproportionately and unequally, especially racial/ethnic minorities and foreign-born persons. TB remains one of many diseases and health conditions with large disparities and inequalities by income, race/ethnicity, educational attainment, and other sociodemographic characteristics.
Why Is This Important?
The rate of Tuberculosis (TB) in the Arkansas Marshallese community is higher than any other population in the state. There have been 191 reported cases over a 21-year span with 3 major outbreaks (in 2004, 2014, and 2017). Most of these cases happen to children.
Why Is This Important?
With antibiotics being the most commonly prescribed drugs, it is estimated that up to half of the antibiotic use is not needed. Antibiotic resistance caused by the overprescribing of antibiotics is a public health threat that has a significant impact upon the healthcare system, demonstrated by longer and more costly treatments, longer hospital stays, and extra doctor visits. In Arkansas, there are 1,154 antibiotic prescriptions filled for every 1000 people. This is the seventh highest rate in the United States.
Antibiotics dispensed in U.S. community pharmacies in 2018
National: 763 per 1,000 population
Arkansas: 1011 per 1,000 population
Data Source: Centers for Disease Control and Prevention
Health Disparities
Drug related death rates are highest in the non-Hispanic White population.
Data Source: Centers for Disease Control and Prevention WONDER
Note: Age-adjusted rates are shown. ICD-10 codes X40-X44, X60-X64, X85, Y10-Y14.
Why Is This Important?
The issue of drug misuse and addiction has become a serious public health emergency for the United States over the past twenty years. In 2021, almost 107,000 Americans died from drug overdoses, making overdoses cause more deaths than motor vehicle crashes. Arkansas has also seen a rise in drug overdoses in recent years and in 2021, 637 Arkansans died from a drug overdose with opioids being the most widely identified drug.
Health Disparities
The health risks and impacts of climate change are not equally distributed across people, communities or nations, and they differ by geographical location, race/ethnicity and income. For individuals, two critical components that make them more susceptible to the effects of climate change are pre-existing health status and living conditions. As these conditions are disproportionately found in low-income and communities of color, they are, and will continue to be, unequally affected by the health impacts of climate change. How this will be manifested in Arkansas specifically, has not yet been determined.
Why Is This Important?
The effects of climate change on human health are significant and, across the globe, increases in starvation, heat injury, allergy, mental health problems, and infectious diseases, are being recorded. While the worst effects of climate change are, and will continue to occur at the north and south poles and at the equator, changes are having an impact across the planet and in Arkansas as well. While an increase in night-time temperatures is already being recorded, other changes, potentially resulting from climate change, are anticipated including rainfall rates, pollen levels, and air pollution levels. Many of these changes will directly and indirectly impact the health of individuals and the healthcare system in general. As an example, treatment for heat exhaustion in Pulaski County during the last 7 years has nearly doubled, and these treatments happened when temperatures were above 90 degrees F.
Number of individuals in Pulaski County hospitalized with heat exhaustion 2012-2018
Data Source: Hospital Discharge Data, Health Statistics Branch, Arkansas Department of Health
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